Covered Entity Details

CAH381323-24 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL (Active) - information as of 4/28/2025 1:48:31 AM

Main Details

Name

MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL

Subdivision Name

LCH Hematology & Oncology - LCH - Hematology & Oncology

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381323-24

Medicare Provider Number

381323

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/10/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/18/2024

Last Recertification Date

Contacts

Authorizing Official

Samaritan Health Services
Daniel Smith, VP Finance/CFO
(541) 768-5390

Primary Contact

Samaritan Lebanon Community Hospital
Daniel Rackham, Chief Executive Officer
(541) 451-7914

Addresses

Street Address

525 N Santiam Hwy
Lebanon, OR 97355

Billing Address

Samaritan Health Services, Inc.
PO Box 3000
Corvallis, OR 97339

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OR	500657700,026638,500651644	1396005641,1689625980

Shipping Addresses

Shipping Address 1

Samaritan Lebanon Community Hospital
525 N Santiam Hwy
Lebanon, OR 97355

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH381323-01	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Samaritan Hemotology and Oncology Consultants	525 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-02	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Sweet Home Family Medicine	1289 49th Avenue	Sweet Home	OR	Active
CAH381323-03	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Samaritan Cardiology	425 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-04	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Brownsville Family Medicine	157 Spaulding Avenue	Brownsville	OR	Active
CAH381323-05	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Mid-Valley Medical Plaza	425 North Santiam Hwy	Lebanon	OR	Terminated
CAH381323-06	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH ER Physicians	525 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-07	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Main Street Family Medicine	191 North Main Street	Lebanon	OR	Active
CAH381323-08	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Park Street Clinic	325 Park Street	Lebanon	OR	Active
CAH381323-09	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Samaritan Orthopedic and Sports Medicine	100 Mullins Drive Suite D-3	Lebanon	OR	Terminated
CAH381323-10	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Urgent Care	35 Mullins Drive Suite 2	Lebanon	OR	Active
CAH381323-11	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Fam Med Residency Clinic	425 N SANTIAM HWY	LEBANON	OR	Active
CAH381323-12	Child	CAH	SAMARITAN LEBANON COMM HOSPITAL	Urology	525 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-13	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Medication Management - Lebanon	425 North Santiam Highway	Lebanon	OR	Active
CAH381323-14	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH WOUND CARE	679 Main Street	Sweet Home	OR	Terminated
CAH381323-15	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	MID-VALLEY HEALTHCARE, INC. / LCH Anticoag A Park Street	325 PARK ST	LEBANON	OR	Terminated
CAH381323-18	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Medication Management - Sweet Home	1289 49th Avenue	Sweet Home	OR	Active
CAH381323-19	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Mid valley Healthcare, inc. DBA Samaritan Lebanon Community Hospital - LCH Sam Lebanon Health Ctr	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-20	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Health Center - Pediatrics - LCH Health Center - Pediatrics	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-21	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Samaritan Fam Med SLHC - LCH Samaritan Fam Med SLHC	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-22	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Health Center - OB-GYN - LCH Health Center - OB-GYN	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-23	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Diabetes Management - LCH Diabetes Management	525 N. Santiam Hwy	Lebanon	OR	Active
CAH381323-24	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Hematology & Oncology - LCH - Hematology & Oncology	525 N Santiam Hwy	Lebanon	OR	Active
CAH381323-25	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH SH Urgent Care WI RHC - LCH - Urgent Care	1289 49th Avenue	Sweet Home	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Rackham, Daniel Chief Executive Officer Samaritan Lebanon Community Hospital 5414517107	Rackham, Daniel Chief Executive Officer Samaritan Lebanon Community Hospital 5414517914	10/9/2024 10:28 AM
Contacts	Primary Contact	Update	Profile Change Request	Rackham, Daniel Chief Pharmacy Officer Samaritan Health Services 5417686177	Rackham, Daniel Chief Executive Officer Samaritan Lebanon Community Hospital 5414517107	10/8/2024 1:41 PM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Smith, Daniel VP Finance/CFO Samaritan Health Services 5417685390	7/18/2024 10:46 AM
Details	340B ID	Update	New Registration		CAH381323-24	7/18/2024 10:46 AM
Details	Entity Name	Update	New Registration	SAMARITAN LEBANON COMM HOSPITAL	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	7/18/2024 10:46 AM
Details	Entity Subname	Update	New Registration	LCH Hematology & Oncology - LCH	LCH Hematology & Oncology - LCH - Hematology & Oncology	7/18/2024 10:46 AM
Dates	Participating Approval Date	Update	New Registration		7/18/2024 10:46:44 AM	7/18/2024 10:46 AM
Details	State	Update	New Registration	Pending	Approved	7/18/2024 10:46 AM
Dates	Signed By Date	Update	New Registration		7/10/2024 7:55:55 PM	7/18/2024 10:46 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/18/2024 10:46 AM
Addresses	Main Address	Insert	New Registration		525 N Santiam Hwy Lebanon, OR 97355	7/10/2024 5:23 PM
Addresses	Billing Address	Insert	New Registration		Samaritan Health Services, Inc. PO Box 3000 Corvallis, OR 97339	7/10/2024 5:23 PM
Addresses	Shipping Address	Insert	New Registration		Samaritan Lebanon Community Hospital 525 N Santiam Hwy Lebanon, OR 97355	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		500657700	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		026638	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		500651644	7/10/2024 5:23 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	7/10/2024 5:23 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1396005641	7/10/2024 5:23 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	7/10/2024 5:23 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1689625980	7/10/2024 5:23 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	7/10/2024 5:23 PM
Contacts	Primary Contact	Insert	New Registration		Rackham, Daniel Chief Pharmacy Officer Samaritan Health Services 5417686177	7/10/2024 5:23 PM
Contacts	Authorizing Official	Insert	New Registration		Smith, Daniel VP Finance/CFO Samaritan Health Services 5417685390	7/10/2024 5:23 PM
Details	Assistance Received From Date	Insert	New Registration			7/10/2024 5:23 PM
Details	Assistance Received To Date	Insert	New Registration			7/10/2024 5:23 PM
Details	Last Recertification Date	Insert	New Registration			7/10/2024 5:23 PM
Details	Grant Number	Insert	New Registration			7/10/2024 5:23 PM
Details	340B ID	Insert	New Registration			7/10/2024 5:23 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/10/2024 5:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/10/2024 5:23 PM
Details	Medicare Provider Number	Insert	New Registration		381323	7/10/2024 5:23 PM
Details	Entity Name	Insert	New Registration		SAMARITAN LEBANON COMM HOSPITAL	7/10/2024 5:23 PM
Details	NOFO Number	Insert	New Registration			7/10/2024 5:23 PM
Details	Program Code	Insert	New Registration		CAH	7/10/2024 5:23 PM
Details	Entity Subname	Insert	New Registration		LCH Hematology & Oncology - LCH	7/10/2024 5:23 PM
Dates	Participating Approval Date	Insert	New Registration			7/10/2024 5:23 PM
Details	State	Insert	New Registration		Pending	7/10/2024 5:23 PM
Dates	Registration Date	Insert	New Registration		7/10/2024 5:23:05 PM	7/10/2024 5:23 PM
Dates	Signed By Date	Insert	New Registration			7/10/2024 5:23 PM
Dates	Start Date	Insert	New Registration			7/10/2024 5:23 PM
Terminations	Termination Comments	Insert	New Registration			7/10/2024 5:23 PM
Terminations	Termination Date	Insert	New Registration			7/10/2024 5:23 PM
Terminations	Termination Effective Date	Insert	New Registration			7/10/2024 5:23 PM
Terminations	Termination Reason	Insert	New Registration			7/10/2024 5:23 PM